Key Facts

• Skilled nursing facilities employed 1,588,600 people in June 2026, the first month above their February 2020 level of 1,586,500 (BLS via FRED).
• Since June, growth has stopped. Employment was 1,587,400 in September 2026 (preliminary), while health care as a whole added 371,800 jobs over the past year (BLS).
• Certified nursing assistant (CNA) turnover was 42.34% in 2025, still the highest of any nursing home role (LeadingAge, HCS Salary & Benefits Report).
• 91% of nursing home operators rated recruiting new staff as difficult, even as agency staffing fell about 44% since 2022 (AHCA).
• Skilled nursing occupancy topped 87% in early 2026, the highest since 2016 (Skilled Nursing News, citing NIC MAP data).

Nursing Homes Are Back to 2020 Staffing. It Took Six Years.

Nursing homes took years longer than the rest of health care to win back the workers they lost in 2020.

As late as December 2024, skilled nursing facilities employed 1,518,700 people, according to Bureau of Labor Statistics data. That was about 68,000 below February 2020.

Then 2025 turned into a real rebuilding year. Employment rose from 1,518,700 in December 2024 to 1,569,900 in December 2025, a gain of 51,200 jobs in revised BLS data.

That’s a bigger number than the industry itself reported at the time. In January 2026, the American Health Care Association said nursing homes had added “more than 40,700” workers in 2025 and still needed 26,500 more to get back to pre-pandemic levels (AHCA, Jan. 28, 2026).

Both figures were based on BLS data available at the time. BLS later revised the series upward, and the gap AHCA described closed within months.

By June 2026, skilled nursing employment reached 1,588,600, just above the February 2020 level of 1,586,500 (BLS via FRED).

On paper, the recovery was complete.

Table 1: Skilled nursing facility employment, 2020 to 2026

Month	Employees (seasonally adjusted)	Versus February 2020
February 2020	1,586,500	Baseline
December 2024	1,518,700	-67,800
December 2025	1,569,900	-16,600
June 2026	1,588,600	+2,100
September 2026 (preliminary)	1,587,400	+900

Then Hiring Stalled

The recovery didn’t keep going. It stopped almost exactly at the finish line.

From June to September 2026, skilled nursing employment slipped by 1,200 jobs, from 1,588,600 to 1,587,400 (BLS via FRED).

The initial August estimate showed nursing homes adding just 100 jobs, a month Skilled Nursing News described as “nearly flat.” September’s preliminary estimate showed a loss of 1,600 (BLS).

Meanwhile, the rest of health care kept hiring. Total health care employment grew from 18,181,800 in September 2025 to 18,553,600 in September 2026, an increase of 371,800 (BLS).

Skilled nursing added 30,100 jobs over the same 12 months. That’s real growth, but almost all of it came before June.

The broader nursing and residential care category also lost 8,700 jobs between August and September 2026 (BLS).

One caution: August and September figures are preliminary. BLS revises them in the following two monthly reports, so a single flat month shouldn’t be overread. Three months without growth is harder to dismiss.

Why “Recovered” Doesn’t Mean “Fully Staffed”

Getting back to 2020 headcount sounds like the end of the story. It isn’t, because demand in 2026 is not what it was in 2020.

More residents per bed

Skilled nursing occupancy topped 87% in the first quarter of 2026, the highest level recorded since 2016, according to NIC MAP data reported by Skilled Nursing News.

New building is close to a record low. The sector added new inventory for the first time since 2017, but high construction and financing costs keep development frozen (same source).

Put those together and nursing homes are filling existing beds rather than adding new ones. The same 1.59 million workers are caring for fuller buildings.

A bigger older population

The population most likely to need nursing home care is growing fast. Census Bureau projections cited in AHCA’s 2026 workforce report put Americans aged 80 and older at 13.15 million in 2022 and 14.75 million in 2025.

The same projections reach 30.52 million by 2060, roughly double today’s level.

Operators still say hiring is hard

AHCA’s most recent provider survey, from May 2025, asked nursing homes how hard it is to recruit new staff (AHCA 2026 report):

Rating	Share of providers
Very difficult	26%
Somewhat difficult	65%
Somewhat easy	8%
Very easy	2%

That’s 91% saying recruiting is difficult.

The same survey found 62% said their overall workforce situation had improved over the past year. Both things are true at once. Conditions got better, and hiring stayed hard.

Openings remain high across health care

Health care and social assistance employers had 1,479,000 job openings in September 2026 (preliminary), an openings rate of 5.8% (BLS JOLTS).

That compares with 1,417,000 a year earlier. JOLTS doesn’t publish a nursing-home-only series, but nursing homes recruit from the same labor pool as hospitals, clinics and home health agencies.

CNAs: The Job That Carries the Turnover

If there’s one role at the center of nursing home staffing, it’s the certified nursing assistant.

CNAs help residents with daily activities such as bathing, dressing and eating (BLS OOH). The federal staffing rule finalized in 2024 would have required 2.45 hours of nurse aide care per resident per day, more than any other role.

An entry-level job with a short training path

Nursing assistants typically complete a state-approved education program and pass a state competency exam. No related work experience is required, according to the BLS Occupational Outlook Handbook.

There were about 1,505,900 nursing assistant jobs in 2025. Nursing care facilities employed 36% of them, the largest single share, followed by hospitals at 32% (same source).

BLS projects about 203,300 openings for nursing assistants and orderlies each year through 2035. Most of those come from replacing workers who move to other occupations or leave the workforce, not from new positions.

Turnover is falling, but still the highest of any role

CNA turnover in nursing homes was 42.34% in 2025, down from 44.16% in 2024, according to the 2025-2026 Nursing Home Salary & Benefits Report from Hospital & Healthcare Compensation Service, LeadingAge and AHCA (LeadingAge).

That’s an improvement. It’s also still the highest turnover rate of any nursing home department.

Pay doesn’t give nursing homes a clear edge

Nursing homes pay CNAs slightly more than most competing settings, but not by much. Median annual pay for nursing assistants in May 2025, by employer type (BLS OOH):

Employer type	Median annual wage
Government	$47,050
Nursing care facilities	$43,000
Hospitals	$42,310
Continuing care and assisted living	$39,490
Home health care services	$38,040
All nursing assistants	$42,260

Nursing homes raised CNA wages 3.41% in the most recent salary survey (AHCA 2026 report). Raising compensation was the top retention strategy, cited by 92% of providers (same source).

An edge of about $700 a year over hospitals is a thin margin when both are recruiting from the same pool of certified aides.

The jobs went elsewhere first

Other parts of health care recovered years before nursing homes did. AHCA’s analysis of BLS data from February 2020 to December 2025 found home health employment up 19.0%, hospitals up 10.9%, and outpatient care and physicians’ offices each up 13.4%. Nursing homes were down 1.7% (AHCA 2026 report).

That analysis used data available in January 2026, before BLS revisions. The direction holds: every other major care setting grew well past its 2020 size while nursing homes were still catching up.

Less Agency, Less Churn, Less Room for Error

The last few years did bring real gains for nursing home operators.

Use of temporary agency staff dropped from 9.93% in the fourth quarter of 2022 to 5.60% in the second quarter of 2025, a decline of nearly 44%, according to CMS Payroll Based Journal data analyzed by AHCA.

Total nursing staff turnover has been declining since mid-2022, AHCA reports (same source).

Agency nurses and aides are expensive, and they don’t know the residents. Replacing them with permanent staff is better for budgets and for care.

But it also changes the math. A facility that cut agency use depends more on its own hiring pipeline. When that pipeline stops growing, as it did after June 2026, there’s less of a cushion to fall back on.

At the sector level, health care quits have eased. Health care and social assistance had a quits rate of 2.0% in September 2026 (preliminary), down from 2.2% a year earlier and slightly below the 2.3% rate for all private employers (BLS JOLTS).

Fewer people leaving is good news. It doesn’t create new workers, though, and new workers are what a fuller, older resident population requires.

Federal Policy Is Aimed at Nurses, Not Aides

Two federal moves in the past year shaped the nursing home staffing picture. Neither does much for CNA hiring.

The staffing mandate is gone

In 2024, CMS finalized a rule that would have required nursing homes to provide 3.48 total nursing hours per resident per day, including 0.55 hours from registered nurses and 2.45 hours from nurse aides, plus a registered nurse onsite 24/7.

HHS repealed those staffing requirements on December 2, 2025 (HHS).

That removed a compliance deadline. It didn’t remove the staffing need behind it.

$275 million for nurses, none for CNAs

On October 23, 2026, CMS and the states announced the Nurses for Nursing Homes initiative, a $275 million program funded by civil monetary penalties collected from nursing homes (CMS).

It offers up to $40,000 in student loan repayment, a $10,000 stipend, or both, to registered nurses and licensed practical or vocational nurses who commit to three years at a rural or higher-shortage nursing home. CMS expects it to support more than 4,000 nurses.

CNAs are not eligible. The nursing home role with the highest turnover is outside the program.

A workforce that depends on immigrants

About 25% of direct care workers in nursing facilities are immigrants, and 9% are noncitizens, according to a July 2026 KFF analysis of 2024 Census survey data. Across all direct care settings, the immigrant share is 30%.

That means immigration policy is workforce policy for nursing homes. Any change in how many foreign-born workers can enter or stay in the U.S. shows up directly in the CNA labor pool.

Why EB-3 Fits This Staffing Problem, and Where EB3.work Comes In

Put the data together and the shape of the problem is clear.

Nursing homes have already won back their 2020 headcount. Domestic hiring stalled at that point, while occupancy and the 80-plus population kept rising.

The role with the most churn, the CNA, is entry-level, is excluded from the new federal incentive money, and already relies on immigrant workers for a quarter of the direct care workforce.

That combination is a close fit for the EB-3 visa, and for EB3.work, which specializes in entry-level EB-3 hiring. Here’s how it lines up with the specific problems in the data.

It adds workers rather than reshuffling them

Higher pay, sign-on bonuses and agency contracts mostly move existing CNAs from one employer to another. With hospitals, home health and assisted living all competing for the same people, that’s a zero-sum game.

The EB-3 program brings in workers who aren’t in the U.S. labor pool today. For a sector whose domestic hiring has flattened, that’s new supply, not a bidding war.

It fits an entry-level role

The EB-3 visa has an “Other Workers” category for jobs that require less than two years of training or experience. The CNA role, with a short state-approved training program and no experience requirement (BLS OOH), sits squarely in that range.

EB-3 Other Workers is the main category EB3.work handles, which is why the company focuses on entry-level, high-turnover roles like these.

CNAs also aren’t on the list of health care occupations that need a federal health care worker certificate (VisaScreen) for immigration. That list covers nurses, therapists, physician assistants and lab professionals, not nursing assistants (8 CFR 212.15(c)).

It’s built for retention

EB-3 workers arrive as lawful permanent residents with a green card, not on a temporary visa that expires. That makes the program a match for the core problem in the turnover data: 42.34% of CNAs turning over every year.

Employers sponsor a worker for a specific, permanent position. Compare that with agency staff or traveling aides, whose assignments are built to end.

Facilities can see what CNA turnover currently costs them with EB3.work’s free ROI Workforce Calculator.

It fills a gap the policy money doesn’t

The $275 million federal program targets licensed nurses. Nursing home operators who need CNAs, the bulk of their hands-on staff, have to build that pipeline themselves. EB-3 is one of the few long-term tools that works at the aide level.

What EB3.work handles

Most nursing homes don’t have an immigration team, and the EB-3 visa involves three federal agencies: the Department of Labor, USCIS and the State Department.

EB3.work specializes in the EB-3 Other Workers category for entry-level roles. It works with immigration attorneys on every case and runs the process through a platform that tracks each worker’s progress.

The employer pays a flat fee of around $1,500 in total. That covers the PERM attorney fee and the local recruitment advertising PERM requires.

Employers interview pre-screened foreign candidates, and EB3.work’s free tools help with planning: the Employer Eligibility Calculator, Prevailing Wage Calculator, ROI Workforce Calculator and EB-3 Processing Times.

Because the fee doesn’t grow with the number of workers, sponsoring a group of CNA-track workers each year costs the same as sponsoring one. That’s how a facility builds a steady pipeline instead of a one-time fix.

The tradeoffs are real

EB-3 isn’t fast. The process runs through prevailing wage determination, PERM labor certification with a required test of the U.S. labor market, an I-140 petition and visa processing. It takes years, not months, so it works as a multi-year pipeline, not a fix for next month’s schedule.

CNAs must also complete a state-approved program and pass a state competency exam (BLS OOH). A caregiver trained abroad still has to meet those state requirements before working as a CNA, so facilities need a plan for that step.

Employers must also be able to show they can pay the offered wage.

For a sector that just learned domestic hiring alone stops at 2020 levels, a slower, permanent source of CNAs can be worth more than a faster, temporary one.

Frequently Asked Questions

What This Means for Employers

The numbers point to a market where waiting for a hiring rebound is unlikely to work. Here’s what the data supports.

• Plan for flat domestic hiring, not a rebound. Skilled nursing employment has been flat since June 2026 while occupancy is the highest since 2016. Budget and schedule as if the local CNA pool won’t grow on its own.
• Protect the agency gains. Agency use is down nearly 44% since 2022. Keeping it there means in-house float pools and flexible scheduling, so a few resignations don’t push you back to agency contracts.
• Benchmark CNA pay against hospitals and government, not just other nursing homes. The median edge over hospitals is about $700 a year, and government employers pay more. That’s the real competition for your aides.
• Grow your own CNAs. Sponsoring state-approved CNA training for dietary, housekeeping or other entry-level staff turns existing employees into certified caregivers in a role with a short training path.
• Build a long-term international pipeline through EB-3. CNA-track roles fit the EB-3 Other Workers category, CNAs are exempt from VisaScreen, and sponsored workers arrive as permanent residents. Plan for a multi-year timeline and for state certification after arrival.

Sources

• EB3.work, “EB-3 Visa for Employers”: https://employer.eb3.work/eb3-visa-process/eb-3-visa-for-employers/
• U.S. Bureau of Labor Statistics, All Employees, Skilled Nursing Care Facilities (CES6562310001), via FRED, data through September 2026: https://fred.stlouisfed.org/data/CES6562310001.txt
• U.S. Bureau of Labor Statistics, JOLTS Table 1 (job openings), September 2026: https://www.bls.gov/news.release/jolts.t01.htm
• U.S. Bureau of Labor Statistics, JOLTS Table 4 (quits), September 2026: https://www.bls.gov/news.release/jolts.t04.htm
• U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Nursing Assistants and Orderlies: https://www.bls.gov/ooh/healthcare/nursing-assistants.htm
• U.S. Department of Health and Human Services, minimum staffing standards repeal, December 2, 2025: https://www.hhs.gov/press-room/hhs-cleanup-federal-nursing-home-minimum-staffing-standards-rule-expands-access-rural-tribal-health-care.html
• 8 CFR 212.15, Certificates for foreign health care workers: https://chanrobles.com/usa/uslaws/cfr/title08/8-1.0.1.2.15.0.1.15.php